Harden: I want to ask one more question about your background, because
we covered this in terms of your motivation. Was your parents' interest
in social issues and yours rooted perhaps in religion or rooted in civic
activity? Can you pin it down? Was it both of the above?

Grady: I think it was probably not one over the other. Certainly my parents
are very devoutly Catholic, and there is some service in the sense of
the Catholic religion. But I think it is goes beyond that. There is a
civic duty. Again, although my father was the orchestrator of much of
the activity that I described earlier, I think perhaps the influence in
this regard was really my mother. She was more behind the scenes, but
always there, always pushing it. Still, to this day, she is very active
and does a number of things in the community.

Hannaway: That is good to hear. We want to know about your coming to
the NIH, which was in 1983, and you just mentioned that you knew already
that you were coming when you were at the governor's school. Can you tell
us how it happened that you came to the NIH, and then we will ask you
questions about your experiences here.

Grady: We know how people put together their motivations in retrospect.
I had a job in 1976, 1977, and 1978, maybe, at Tufts New England Medical
Center. I worked there on an NIH-funded clinical study unit–it was
a GCRC [General Clinical Research Center]–and I loved that job.
Yet–I was just telling the story to someone the other day–we,
at that time, had two major categories of studies. One was endocrine and
the other was hematology-oncology, and both of them very powerful experiences.
But the hem-onc studies were primarily bone marrow transplants for children
and for some adults with leukemia or aplastic anemia. These were the early
days of bone marrow transplants, where the patient was in what they called
the life island, that is, they were completely surrounded by plastic.
Everything that we did, we did through double layers of protection and
through this plastic. It was a very elaborate contraption. Most of those
people died; almost all of them died.

I can remember at the time being motivated to go back for a master's
degree in public health because I could not quite justify in my mind this
gross expenditure of resources, time, money, and people's efforts on something
which ended up so much a failure. That is why I went to the school for
public health and did the public health degree, taught public health,
went to Brazil, which I would call public health work, although I was
in a hospital, and then came back to the research, which was an interesting
cycle.

But when I came back from Brazil to
the United States, I had an image in my mind of what I wanted. I said
to people that I wanted the perfect job and the perfect place to live.
Everybody asked, “Well, what is that?" I explored several possible
jobs in New England, which was where I had been previously. I almost accepted
one job, which was a research job also, at the Brigham [Brigham and Womens
Hospital].

But I was very much attracted
to the research aspects of being at the NIH. I knew Washington a little
from having gone to Georgetown [University School of Nursing]. So I specifically
wanted a job at the NIH, and I called the Nursing Department and basically
was told that there was nothing. Then I saw an advertisement for a job
at the NIH in the New York Times the following Sunday, and I
said, “How could this be?" I responded to the advertisement.
I became pretty much open to any possibility in terms of a job.

In fact, the job in the advertisement
that I responded to and applied for was a job as an educator. When I came
and interviewed and met the people, the person who ultimately hired me
said, “I want to hire you, but not for that job. I want you for
a different job.” I said, “Tell me more.” I came as
what is called a clinical nurse specialist; the position happened to be
in the infectious disease area.

Much of what they wanted me to do initially–I do not know what
the right words are–was to advance the level of knowledge of the
nursing staff in immunology, because immunology was driving many of these
infectious disease studies, and certainly much of the work in that area
is and was immunology. So I came to the NIH and immediately, one of the
first things I did was to develop a course in immunology, which I taught
for several years to the Nursing Department. In fact, somebody asked me
this morning, “Why can't you teach that course again?” I said,
“My life has taken a little bit of a different direction.”

Harden: Let me get you to explain where you learned your immunology,
because that is the time when cellular immunology was just...

Grady: Exploding.

Harden: I tried to find materials about cellular immunology at that point,
and it was very hard.

Grady: It was very
hard. When I took the job, the person who hired me said, “We want
you to teach a course in immunology.” I said, “I don't know
anything about immunology. How can I teach immunology?" She said,
“You know as much as anybody else. You find out, and then you teach
the rest of the staff.”

I took two, maybe three, FAES [Foundation for Advanced Education in the
Sciences] courses in immunology, I read many books, and I talked to all
the investigators in NIAID [National Institute of Allergy and Infectious
Diseases] that were doing intramural immunology. After everything that
I read, I would go back and say, “This doesn't quite make sense.
Explain it to me.” After a time I felt like I knew a little of the
basics. As I put the course together, I relied on the people in that institute
to help me make sure that the things I was saying were correct. They reviewed
materials for me and helped me update things. It was a very supportive
group to work with in terms of some of those efforts.

Harden: Let me pin down one more matter here, too. You actually were
hired as a nurse. You were paid by the Clinical Center, and the Clinical
Center assigned you to the NIAID wings?

Grady: That is right.

Harden: Did you ever move into working for NIAID?

Grady: No.

Harden: It has always been the Clinical Center?

Grady: Yes.

Harden: We have been trying to sort this out with everyone we interview.

Grady: No, I never worked for NIAID. I worked during those years with
NIAID because I was assigned to those areas clinically, but I always worked
for the Clinical Center, until I went to NINR [National Institute of Nursing
Research].

Then, clinically, AIDS was beginning on those units in those days, and
it was really only beginning. I mean, there was a handful of patients,
but it was clearly...

Harden: Is this 1983 that we are talking about?

Grady: 1983.

Harden: Yes.

Grady: But it was clearly something that was going to grow. That was
obvious. And there was much interest on the part of the investigators
and a lot of interest and concern on the part of the nurses. It was a
natural thing for me to start to learn as much as I could about it as
things were being discovered; and that is what I did. It became, over
time, the area on which I focused the most attention. In the very beginning,
that was not true. I learned as much as I could about it, but I was also
learning about Wegener's granulomatosis and the other vasculitis diseases,
and some of the allergic diseases that were being seen up there, and these
infectious diseases, about which I felt like I had a little bit of an
edge on information, since I had seen some of them in their real setting
and other people had not.

Hannaway: Could you describe your first involvement with AIDS patients?

Grady: Yes, I think I can. Some of that is a little hazy. Some of the
patients that I remember from late 1983 and 1984 were the patients to
whom I became the most attached. I learned an incredible amount from them
and became very close to some of them. Amazingly, there are two who are
still alive and come here, and whom I still try to see whenever they come.

But in those early days, there were a couple of studies that I remember
very specifically because of the nature of the studies and because of
some of these individual people. One of them was a study of IL-2 [interleukin-2],
which, ironically, is still going on, but in those days it was a very
different product and there was a very different approach and many problems
in terms of the way it was tolerated by people. Even though I was a clinical
nurse specialist, I did take a couple of patients as primary patients,
and the patients–I cannot remember if I volunteered for them or
was assigned to them–were HIV patients on IL-2 protocols.

Harden: You, as a nurse, at that point interfaced with the physicians
whose protocols these patients were on?

Grady: The clinical nurse specialist's job is a very interesting job.
It is in some respects undefined, and in other respects defined in a way
that means it covers a lot of territory. They talk about it as advanced
practice, which means you can and do take care of patients, but the primary
responsibility that you have is not to have a caseload of patients, but
to mentor and oversee the practice of the other members of the nursing
staff and bring it to the highest level possible. That is done through
modeling, education, working together, hands-on stuff, and research, to
the extent it is possible.

I did take some patients in those days, but I spent a lot of time with
the staff. With the investigators, I felt as though much of what I was
supposed to do was to help make not only the goals of, but also, what
was probably more important, the day-to-day operational aspects of the
research understandable to the nursing staff. I also had to facilitate
it so that the people would do what they had to do according to the protocol
in the way that it got done and was of high quality, but did not take
precedence over taking care of the patients. Do you see what I mean? It
was somewhat of a balancing act in that regard.

I spent a lot of time reading and interpreting protocols, putting together
the tools, testing out equipment, teaching nurses about the studies, developing
educational materials for patients about the studies that the nurses could
use, and things like that.

Hannaway: What problems would you say came to the fore most quickly?
Was it concerns by nurses about safety, either their personal safety or
the difficulties of working with patients with this syndrome, and all
the range of infections that occurred? How would you describe it?

Grady: Certainly the concern about safety was one that was always there.
But I have to say that, in my opinion, the Clinical Center did a much
better job of dealing with that than did many other institutions. I had
the opportunity at times to talk to nurses in a variety of other institutions–private,
around the country, local, both. In some places, safety was a very big
problem. In this building, it was not. It was a concern. Everybody was
always concerned, legitimately. We did not know what we were dealing with
in those early days. But the investigators that we were working with and
the hospital epidemiology people were very good about telling us everything
they knew and bringing everybody together in a room and saying, “This
is what we know, this is what we think. Let's try to work on this together.”
That gave the nurses confidence that they were not being led down a path
of deception, that if anything became known about danger or precautions
that should be taken, we would know about it as soon as anybody else did.

I know that a couple of years later, in 1986, there were still concerns.
I was thinking about that this morning because we had a conversation upstairs
about working with tuberculosis patients, and the nurses' concern about
safety is legitimate. In 1986, when I was pregnant and was working in
the area, there was still confusion about whether or not it was safe,
whether pregnancy was an issue in terms of immunosusceptibility or something
like that. At the time, I also remember, again, talking to all the people
around and getting the data that was available and being pretty assured,
both in my own mind and by the people that I spoke to, that short of a
needlestick or something, in being pregnant, I probably was not at any
risk from the HIV. Now there were other disease problems, CMV [cytomegalovirus]
and some of the other things that some of the AIDS patients and others
had, that may have been more of a problem.